Birla High School (Jr.

Section)
1, MOIRA STREET, KOLKATA-700017

Form No.____________

APPLICATION FORM FOR ADMISSION TO CLASS - NURSERY

This Application form has to be filled for admission. Mere filling the form does not ensure admission. Incomplete and
incorrect form will be treated as invalid. The application form must be filled in by hand in block letters.
1.

2.

3.

a)

Candidates Name ___________________________________________________________________________________

b)

Date of Birth _____________________________________ Blood Group _______________________________________

(Photo copy of birth certificate issued by local authority to be attached)

c)

Residential Address __________________________________________________________________________________

____________________________________________________________________________________________________

d)

Distance from School in Kms (approx) __________________________________________________________________

e)

Tel No & Email id for Communication __________________________________________________________________

__________________________________________________________________________________________________

f)

Mother Tongue _______________________________________________________________________________________

g)

History of illness, major operation, physical impairment if any ______________________________________________

____________________________________________________________________________________________________

h)

Whether SC/ST/OBC/Belonging to the weaker section of society) __________________________________________

i)

Present School _______________________________________________________

a)

MOTHERS NAME _____________________________________________________________________________________

b)

Qualification ________________________________________________________________________________________

c)

Occupation _________________________________________________________________________________________

d)

Designation _____________________________________________________ Mobile ____________________________

e)

Name, Address & Tel. No. of Organisation _______________________________________________________________

____________________________________________________________________________________________________

f)

Special Interest ____________________________________________________________________________________

a)

FATHERS NAME ____________________________________________________________________________________

b)

Qualification ______________________________________________________________________________________

c)

Occupation ________________________________________________________________________________________

d)

Designation _____________________________________________________ Mobile ____________________________

e)

Name, Address & Tel. No. of Organisation ______________________________________________________________

___________________________________________________________________________________________________

f)

Special Interest ____________________________________________________________________________________

Recent colour photograph

of
candidate

Class _____________________

4.

Whether parent is an ex-student of Birla High School ___________________________________________________

5.

Details of other children:

Recent colour photograph

of
Mother

Recent colour photograph

of
Father

Name ___________________________________________ Age ________ School ___________________________________________________ Class ______

Name ___________________________________________ Age ________ School ___________________________________________________ Class ______
6.

Full particulars of the guardian other than parent if any ____________________________________________________

We solemnly confirm that the particulars given above are correct and true to the best of our knowledge.

Date ________________________ Signature of Mother ___________________________________ Signature of Father __________________________________

THE ADMISSION PROCESS AND GRANT OF ADMISSION TO CHILDREN BELONGING TO WEAKER SECTION & DISADVANTAGED GROUP IN THE NEIGHBOURHOOD SCHOOLS IS SUBJECT TO THE
PROVISIONS OF THE RIGHT OF CHILDREN TO FREE AND COMPULSORY EDUCATION ACT, 2009 AND RULES 2012.